Provider Demographics
NPI:1093840167
Name:NUESTRA REHABILITATION CENTER , INC.
Entity Type:Organization
Organization Name:NUESTRA REHABILITATION CENTER , INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WOO
Authorized Official - Middle Name:SUP
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:213-483-3987
Mailing Address - Street 1:545 S ALVARADO ST
Mailing Address - Street 2:A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2903
Mailing Address - Country:US
Mailing Address - Phone:213-483-3987
Mailing Address - Fax:
Practice Address - Street 1:545 S ALVARADO ST
Practice Address - Street 2:SUITE A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2903
Practice Address - Country:US
Practice Address - Phone:213-483-3987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty